| Pneumoperitoneum is named as such due to the presence of free air in the peritoneal cavity. The test of choice for its diagnosis is CT, as it can detect quantities as small as 5cc of air.
Its more frequent causes are rupture of a hollow viscous such as the stomach (peptic ulcer or cancer), colon cancer, trauma, rupture of a diverticulum, inflammatory bowel disease, mesenteric ischaemia, laparoscopic surgery, etc. There are non-surgical and/or anecdotal causes such as vaginal insufflation as a consequence, for example, of water skiing or oral sex. In 10% of cases the cause is not surgical and it should be managed expectantly without intervention.
The most common causes in these cases are rupture of an intestinal bulla, non-invasive mechanical ventilation, post-endoscopic polypectomy and after cardiopulmonary resuscitation.
It should be distinguished from other entities such as the subphrenic abscess or the syndrome of interposition of the colon (Chilaiditti), whose radiological appearance is similar, but whose treatment is different.
A case of idiopathic spontaneous pneumoperitoneum is presented that did not require surgery.
Autor:
Juan Ignacio
Pérez Calvo
Servicio de Medicina Interna
Hospital Clínico Universitario
Zaragoza
Translation: Kelly
Watt
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